The online version of this article contains one video. The article and the video are online available (https://doi.org/10.1007/s12471-025-01933-8). The video can be found in the article back matter as “Electronic Supplementary Material”.
A woman in her 60s presented with decreased consciousness and respiratory distress after being found collapsed at home. She exhibited a systolic blood pressure difference of > 50 mm Hg between arms. Echocardiography performed in the Emergency Department revealed pericardial effusion, a transvalvular mobile structure through the aortic valve, and aortic regurgitation (Fig. 1a, b). Transoesofagal echocardiography confirmed the suspicion of aortic dissection, disclosing the unique feature on intimointimal intussusception—where the dissected intima prolapses through the aortic valve into the left ventricular outflow tract (LVOT) (Fig. 1c; see video 1 (Electronic Supplementary Material); [1]). Due to hemodynamic instability, the patient was not suitable for pre-operative computed tomography scan and was directly transferred for salvage sternotomy to relieve the cardiac tamponade. Intraoperative findings included a circumferential transverse intimal tear halfway along the ascending aorta, extending to the aortic valve which is characteristic for intimointimal intussusception. Following emergent ascending aorta replacement and aortic valve resuspension, the patient suffered extensive cerebral ischemia, leading to her passing.
Fig. 1
Echocardiography images of intimointimal intussusception. a Transthoracic echocardiography five-chamber view, systolic phase. b Transthoracic echocardiography five-chamber view, diastolic phase. c Transesophageal echocardiography 132°, systolic phase. d Transesophageal echocardiography 132°, diastolic phase. Yellow arrow indicates the intimointimal intussusception
×
This case underscores the importance of comprehensive echocardiographic evaluation in diagnosing aortic dissection, highlighting intimointimal intussusception as a critical, albeit rare, diagnostic clue.
Conflict of interest
G.J. van Steenbergen, R. Brouwers and E. Tan declare that they have no competing interests.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
share
DELEN
Deel dit onderdeel of sectie (kopieer de link)
Optie A:
Klik op de rechtermuisknop op de link en selecteer de optie “linkadres kopiëren”
Het Netherlands Heart Journal wordt uitgegeven in samenwerking met de Nederlandse Vereniging voor Cardiologie. Het tijdschrift is Engelstalig en wordt gratis beschikbaa ...